Victorian Nurses. Back Injury Prevention Project

Transcription

1 Victorian Nurses Back Injury Prevention Project Evaluation Report 2002

2 Victorian Nurses Back Injury Prevention Project Evaluation Report 2002

3 Acknowledgements The Department of Human Services would like to thank the Victorian Nurses Back Injury Prevention Project Advisory Committee, for their support and advice throughout this evaluation and others who contributed their time to the project including: The Injured Nurses Support Group. The Australian Nursing Federation (Victorian Branch). The Victorian WorkCover Authority The program coordinators, who provided valuable feedback on programs. The many nurses, coordinators and payroll staff who completed survey forms and volunteered their views on the programs. Louise O Shea, for her assistance in documenting program contents. The evaluation for this report was conducted by: Dr Jennifer Keating, La Trobe University Melissa Mitchell, Health Arena (Evaluation Project Manager) with special thanks to Bob Powell (Statistical Database Consultant) The Department of Human Services gratefully acknowledges St. Vincent s Hospital and The Royal Melbourne hospital for the photographic component of this Report and the Victorian WorkCover Authority. Published by the Policy and Strategic Projects Division Victorian Government Department of Human Services Melbourne Victoria October 2002 Also published on For additional copies please contact: Nurse Policy Branch Department of Human Services Tel: (03) or visit the website. Copyright State of Victoria 2002 This publication is copyright. No part may be reproduced by any process except in accordance with the provisions of the Copyright Act ( )

4 Foreword The Victorian Nurse Back Injury Prevention Project (VNBIPP) was established in October 1998 to provide funding for health care organisations to assist them to implement programs to prevent back injuries amongst nurses. An Advisory Committee, consisting of representatives from key industry stakeholders and organisations, was formed to oversee the project, which is administered by the Department of Human Services Nurse Policy Branch. The project was established in response to growing concern amongst nurses and the industry regarding the unacceptably high rate of back injuries in the nursing profession and the enormous financial and human costs associated with such injuries. When the VNBIPP was initiated, nurses accounted for more than 54 per cent of compensation claims by health industry workers. The aim of the VNBIPP is three-fold: To assist facilities to implement back injury prevention programs based on no lifting principles. To facilitate long term cultural change in health care organisations and among nursing staff. By encouraging new attitudes, the project aims to eliminate unsafe practices that have traditionally led to a high risk of injury amongst nurses. To assist health care organisations to implement effective procedures for risk identification, assessment and control of patient handling injuries among nurses. This Report provides the results of the external evaluation, commissioned by the Department of Human Services, and undertaken by Healtharena and La Trobe University. The Report aims to determine nurses perceptions of back injury prevention programs, effects of programs on their work practices and to determine the effect of these programs on workplace injuries. This Government acknowledges the outstanding success of the VNBIPP that has been demonstrated in this Report. The evaluation indicates a reduction in WorkCover claims for injuries sustained by nurses by 48 per cent, a reduction in days lost due to injury by 74 per cent, and a reduction in the cost of claims by 54 per cent. These statistics represent an outstanding achievement in back injury prevention. I would like to take this opportunity to thank all the Committee members for their hard work and dedication. In accepting the Report, I am confident that Victorian nurses will now feel that they can practice in a safer, better equipped work environment where they are valued for their crucial contribution to the health of all Victorians. Hon John Thwaites MP Minister for Health EVALUATION REPORT 2002 iii

5 Contents Executive Summary 1 Background 1 Method 1 Key Findings 1 Conclusion 3 Project Background 5 Legislative Framework 6 Victorian Nurses Back Injury Prevention Project (VNBIPP) 7 Project Aims 8 Back Injury Prevention Programs 9 Project Evaluation 11 Evaluation of the Effects of Round 1 Funding 12 Participants 12 Programs 12 Outcome Measures 12 Effects of Round 1 Funding 13 Survey of Nurses 13 Key Findings 13 Indicators of Opportunities to Improve Programs 14 Survey of Program Coordinators 15 Summary of Injury Data 16 Evaluation of the Effects of Round 2 Funding 17 Data Collection Methods 17 Round 2 Participants 18 Programs 18 Outcome Measures 18 Effects of Round 2 Funding 19 Effects of Programs on Injuries Incurred by Nurses 19 Nurse Survey Results 23 Key Findings 23 Indicators of Opportunities to Improve Programs 23 Coordinator Responses 23 Refresher Training 23 Competency Assessment 23 Program Expansion 23 EVALUATION REPORT 2002 v

6 Discussion 25 Conclusion 30 Appendices 31 A: Project Time Frames 31 B: Description of Wards Funded in Round 2 32 C: Round 2. Nurse Survey Responses 33 D: Round 2. Coordinator Survey Responses 34 References 35 Advisory Committee Members 37

7 Executive Summary Background The Victorian Nurses Back Injury Prevention Project (VNBIPP) provided funding to Victorian public health care facilities to implement Back Injury Prevention Programs based on No Lifting principles. These comprehensive programs addressed unacceptable and rising injury numbers in nurses, by eliminating and minimising manual handling when moving patients. This was achieved through the provision of patient handling aids and equipment, educating nurses to be aware that the health and safety of staff and patients are of equal importance, and encouraging nurses to be proactive in identifying hazards and reducing risks of injury in the workplace. This evaluation was commissioned to determine nurses perceptions of programs, effects of programs on their work practices and to determine the effect of these programs on workplace injuries. Methods After programs had been in place for at least 12 months, nurses were surveyed to assess their perceptions of programs effects, attitudes towards program objectives and workplace practices. Data on injuries incurred by nurses working in 72 participating wards/units for the periods two years before and one year before program implementation were compared to injury data for the one-year period that followed implementation. Key Findings The most important finding of this evaluation is that compared to either of the two preceding years, in the 12 months after program implementation there was a large (43 per cent and 48 per cent) and significant (p <.003) decrease in numbers of injury claims made by nurses in participating wards. Most of the reduction in claim numbers was due to a decrease in the number of claims for sprains and strains incurred during manual handling tasks. Compared to the year preceding implementation, in the 12 months after program implementation claims for back injuries fell by 40 per cent (p =.01). Compared to injuries incurred in the year preceding implementation, in the 12 months after program implementation, claim costs and days lost due to injury were significantly reduced. When sampled at 18.5 (SD 3) months after implementation, costs were reduced by 54 per cent and days lost by 74 per cent. Data for costs and days lost in the post-implementation period require verification at 30 months after program implementation, because the claims in the preimplementation period had existed for up to 30 months at the time of sampling. This verification is necessary for confidence in the magnitude of the observed reduction, because cost and days lost data can accrue when injuries do not resolve. EVALUATION REPORT

8 Nurses clearly welcomed programs and the effect of programs on their work conditions. Nurses reported strong support for the principles of No Lifting and a proactive attitude to risk control and injury reduction. Nurses reported needing: More patient handling equipment. More space to store equipment. More room to operate equipment. Improved response time to their manual handling concerns. Ongoing training in No Lifting practices and ongoing education to keep them informed about advances in patient handling equipment. More support for key staff who coordinate programs. We predict that meeting these needs will enhance program effects. Inadequate or poorly accessible space for storing and operating patient handling equipment is an obstacle to successful program implementation. Methods used to deal with this included renovation, rearrangement of existing space and removal of beds to allow centrally located storage. Health facility managers need to be alerted to the importance of providing work environments that allow all nurses to utilise patient handling equipment. Alterations to workplace environments should occur with consideration of the recommendations in the WorkSafe publication Designing Workplaces for Safer Handling of Patients/Residents (Victorian WorkCover Authority, 1999). Consideration should be given to space requirements to operate and store patient handling equipment when building new health care facilities. Consistent and valid assessment of patient handling requirements is a prerequisite for identifying hazards and reducing risks associated with patient handling. Inconsistent use of such instruments was observed in this evaluation, in part due to the variable quality of options available to participating nurses. Standardised instruments have been proposed in the WorkSafe Victoria (2002) publication Transferring people safely: a practical guide to managing risk handling patients, residents and clients in health, aged care, rehabilitation and disability services and should be tested for utility. Program coordinators reported needing more resources (staff, time and equipment) to successfully implement or sustain programs. Nurses reported that programs suffered when staff dedicated to program coordination left the ward/unit, or the position of program coordinator was discontinued. The importance of dedicated staff for sustaining programs that encourage nurses to comply with safe practices should not be underestimated. The allocation of resources that allow program coordinators and dedicated staff to implement and sustain programs is considered to be critical. Of claims for back injuries in the post-implementation period, 28 per cent were for nurses who had not received training in No Lifting practices and procedures. The development of methods to ensure uniform training of all nurses is a priority. Uniformity of nursing practices is the most expedient path to maximising program effects. Standardised methods to assess competency in No Lifting practices need to be developed and tested. 2 VICTORIAN NURSES BACK INJURY PREVENTION PROJECT

9 Conclusion This evaluation found that the VNBIPP was effective in significantly reducing injuries incurred by nurses in participating wards. It is likely that these encouraging results are a consequence of the comprehensive approach taken by the VNBIPP to reducing the exposure of nurses to hazardous workplace practices. There are clear opportunities for program refinement. Ongoing funding is required for patient handling equipment, to achieve uniform competence in No Lifting practices for all nurses and to ensure that resources are allocated to maintain programs. Sustained monitoring and evaluation of programs for at least 2 more years is advised to verify findings using data from more recently funded facilities, to facilitate estimates of cost benefits and, importantly, to assess program sustainability. EVALUATION REPORT

10 Project Background In 1996, Elizabeth Langford from the Injured Nurses Support Group conducted a survey that examined the impact of injury on nurses, the industry and the community (Langford, 1997). Subsequent to this report, the Australian Nursing Federation (Victorian Branch) adopted a No Lifting Policy. (Copies of the No Lifting Policy can be obtained by telephoning the Australian Nurses Federation (Victorian Branch) on ). This policy was based on the model developed by the Royal College of Nursing in the United Kingdom. When the Victorian Nurses Back Injury Prevention Project was initiated, nurses accounted for more than 54 per cent of compensation claims by health industry workers. The health industry paid around $50 million per year in workers compensation premiums and nurses back injuries accounted for more than half of this amount (Department of Human Services 2000). The Injured Nurses Support Group approached the Minister for Health to tackle the unacceptably high injury rates amongst nurses. The Australian Nursing Federation (Victorian Branch) joined with the Injured Nurses Support Group and together these two groups successfully lobbied for support for a strategy to reduce injuries to nurses. There is agreement that back injuries in nurses and other workers are related to exposure to high physical loads (Frymoyer et al. 1983, Engkvist et al. 1992, Chiou et al. 1994, Vasiliadou et al. 1995, Hignet 1996, Matsui et al. 1997, Smedley et al. 1997, Retsas and Pinikahna 2000, Wallner-Schlotfeldt and Stewart 2000, Engvist et al. 2000). For nurses, exposure to high physical loads occurs during patient transfers (Engkvist et al. 1992, Ulin et al. 1997). Work intensity, static work postures, frequent bending and pushing, velocity of task performance and distance to an object being manipulated have also been identified as risk factors for back injuries (Caboor et al. 2000). The traditional approach to minimising the risk of injury to nurses due to patient handling has been to teach nurses safe manual lifting techniques. There is laboratory-based evidence to suggest that training in correct body mechanics can be learned, but training is poorly transferred to the work environment (Carlton 1987, Wachs and Parker-Conrad 1989). In addition, there is strong evidence that these methods are not effective in reducing the risk of injuries related to patient handling (Linton and Tulder 2001, Hignet 1996, Daltroy et al. 1997). Nelson et al. (1997) argued that effective preventative interventions were critically needed to control the injuries and costs associated with patient handling. If physical loads due to patient handling cause injuries to nurses, the risk of injury should decrease if nurses stop performing hazardous manual handling tasks. Charney (1997) reported a decrease in back injuries in each of ten facilities (mean reduction 69 per cent) that took part in a program where nurses ceased lifting patients. At the inception of the Victorian Nurses Back Injury Prevention Project, the Royal College of Nursing (RCN) in the United Kingdom had for some time been advocating the advantages of eliminating hazardous manual handling by nurses. The RCN reported cases where this had resulted in health care facilities reducing injuries to nurses in the order of 50 per cent. Princess Alexandra Hospital and Mt. Olivet Hospital in Queensland reported comparable results (Garrison 1998, Gorman 1998). Encouraged by these reports, the Department of Human Services implemented a project designed to reduce back injuries in nurses by, wherever possible, eliminating hazardous manual handling tasks. EVALUATION REPORT

11 Legislative Framework The Occupational Health and Safety Act 1985 sets out general duties of care for employers and employees. The Act enables regulations to be made about health and safety of workers. The Occupational Health and Safety (Manual Handling) Regulations 1999 have been written to protect people at work against musculoskeletal disorders caused by manual handling. They set out specific duties for employers and employees. Under the Regulations, an employer must ensure that manual handling risks are eliminated wherever practicable. An employer must not rely on the use of information, training or instruction in manual handling techniques as the sole or primary means of controlling risk. The Code of Practice for Manual Handling 2000 ( the Code No 25, 20 April 2000), approved under Section 55 of the Occupational Health and Safety Act 1985 ( or phone information Victoria ) provides guidance on compliance with the Regulations. The Code of Practice for Manual Handling states that manual handling risks should be eliminated through hazard identification, risk assessment and risk control. Actions to eliminate or reduce the risk of musculoskeletal disorders have the following hierarchy: Alter the workplace or environmental conditions where the manual handling task is carried out. Alter the systems of work used to carry out the manual handling task. Change the objects used in the manual handling task. Use mechanical aids to reduce the forces needed to perform manual handling tasks and improve the postures and movements required to do these tasks. Information, training and instruction about the changes made to manual handling tasks may be provided to workers, but are not considered an acceptable substitute for reducing or eliminating forces acting on the body during manual handling tasks. Also stipulated in the Code of Practice for Manual Handling is that control measures that are implemented must be reviewed to determine if they are adhered to and effective. Under the Regulations, employees are required to cooperate with an employer s actions to identify and assess tasks that involve hazardous manual handling and to comply with risk control measures determined by the employer to be practicable (e.g. altered systems of work or the use of mechanical aids). Although similar legislation has been in place in the United Kingdom since 1992 that should have resulted in widespread adoption of No Lifting practices amongst nurses, nurses patient handling practices have been slow to change. Financing of the purchase of equipment, deficiencies in the assessments of risk of injury, limitations of the physical work environment such as adequate space to operate equipment and training requirements for nurses have been implicated in delaying change in patient handling practices (Garg et al. 1992, Kneafsey 2000). Several authors have reported that nurses may be reluctant to use patient handling equipment (Moody et al 1996, Monaghan et al. 1998). Green (1996) reported that time constraints often determined whether patient transfer equipment was used, as manual handling methods were sometimes perceived to be less time consuming. Hence, when the Victorian Nurses Back Injury Prevention Project was initiated, it was acknowledged that policy change or provision of equipment alone was unlikely to adequately change nursing practices. 6 VICTORIAN NURSES BACK INJURY PREVENTION PROJECT

12 The Victorian Nurses Back Injury Prevention Project (VNBIPP) The VNBIPP was established in 1998 by the Minister for Health to provide funding for health care organisations to assist them to implement programs to prevent injuries to nurses based on No Lifting principles. This was under the auspices of the Department of Human Services. An Advisory Committee was established to oversee the Project; the composition of the Committee varied across time. Key members were representatives from: Injured Nurses Support Group. Australian Nursing Federation (Victorian Branch). Victorian WorkCover Authority. Royal College of Nursing Australia. Victorian Healthcare Association. Occupational Health and Safety Consultants. Clinical nurses. EVALUATION REPORT

13 Project Aims To assist health care facilities to implement back injury prevention programs based on No Lifting principles. Funded programs were designed to eliminate or minimise manual handling associated with moving and transferring patients. To facilitate long term cultural change in health care organisations and among nursing staff to eliminate workplace practices associated with high risk of injury. Manual methods of transferring patients have developed out of necessity over time and have become entrenched practices. Resistance to change in values, attitudes and skills of the nursing culture have been argued to impede attempts to change manual handling practices (Kneafsey, 2000). To assist health care organisations to implement effective procedures for hazard identification, risk assessment and control of patient handling injuries based on the Victorian Manual Handling (1999) Regulations. 8 VICTORIAN NURSES BACK INJURY PREVENTION PROJECT

14 Back Injury Prevention Programs Victorian public healthcare facilities were invited to apply to the Department of Human Services for funding to establish Back Injury Prevention Programs. The Department of Human Services Advisory Committee had advised healthcare facility managers of its intention to provide funds to programs that: Were based on No Lifting principles. Adhered to the Manual Handling Regulations (1999). Were based on an Occupational Health and Safety risk management approach to the prevention of back injuries. Programs that included teaching nurses that safe manual lifting techniques, back care, and exercises were acceptable methods for reducing risks associated with transferring patients did not qualify for funding. Promoted that the health and safety of staff and patients/residents were equally important. Were committed to encouraging nurses to participate fully in implementing and sustaining programs. Proposed advantages of employee commitment include higher quality decisions due to greater knowledge of tasks (May and Schwoerer 1994, Shannon et al 1997). Incorporated consultative mechanisms through which nurses could report their concerns and convey their needs to program coordinators, managers and occupational health and safety staff. Determined the effectiveness of training nurses in the principles and practices of No Lifting by assessing competency across a range of skills such as equipment operation, hazard identification, risk assessment and control, and patient care without performing hazardous manual handling. Included senior management commitment to adequately resource programs. Funding provided by the Department of Human Services was inadequate in most cases to cover the full cost of implementation. Provided resources for programs such as adequate patient transfer equipment, adequate space to store and operate equipment and a dedicated staff member to coordinate the program. Desirable program principles included: Commitment to the elimination of manual lifting wherever possible and training in the use of patient transfer equipment. Commitment to achieving a change from a culture where lifting patients was accepted by nurses as part of the job, to a culture within which nurses no longer considered that the risks associated with these patient handling tasks were acceptable. Establishment of procedures that assisted nurses to identify manual handling hazards, assess the associated risk of injury and develop alternative work strategies to minimise the risk of injury. A condition of funding was that funded facilities take part in ongoing monitoring and evaluation, to identify and solve problems and to meet accountability requirements for public expenditure at facility and project level. EVALUATION REPORT

15 Health care facilities were encouraged to engage the services of consultants who could provide them with the expertise needed to develop and implement back injury prevention programs and provide training to staff. Eighty-two per cent of facilities employed the services of the same provider. Hence, the composition of Back Injury Prevention Programs evaluated in this report was relatively consistent across facilities. Programs typically adhered to the following structure: Management commitment to support the program was obtained. Risks associated with all patient handling tasks within the workplace were assessed. Type and amount of necessary equipment were determined. Equipment procurement was organised. An equipment maintenance program was developed. Abudget for adequate equipment to meet future needs was devised. An adequate number of trainers or staff leaders were provided. Links between middle management and executive management were established, so that programs could be maintained. Methods for monitoring compliance with processes and practices were established. Methods for ongoing training and competency assessment of all staff, including new staff, were established. Regular meetings of trainers/staff leaders were established, to ensure ongoing problem solving. Astructure was provided to ensure that, if patient handling concerns could not be resolved, they were resolved as an Occupational Health and Safety issue. Staff were trained in small groups. Staff and the consultant worked together in the wards with residents/patients, to tailor solutions dealing with specific needs A dedicated program coordinator was appointed by each health care facility to oversee program implementation and management in participating wards. This person was trained to manage the program by the consultant. In addition, the consultant typically trained a number of staff members (who became the program trainers ). These trainers were responsible for the implementation and management of the No Lifting system within their own specific work area. 10 VICTORIAN NURSES BACK INJURY PREVENTION PROJECT

16 Project Evaluation Funding for public health care facilities to implement programs was offered in three rounds (Appendix A). This document reports program effects for the 51 facilities funded in Round 1 and the 28 facilities funded in Round 2. Round 1 and Round 2 funded facilities had implemented programs at the time this evaluation was commissioned. The specific aims of the evaluation were to assess how nurses felt about the programs, to gain insight into obstacles to program implementation, to determine the effects of programs on injuries to nurses and to advise the Department of Human Services about ongoing project management. We entered and analysed the data collected from Round 1 funded facilities, identified strengths and weaknesses of the data collection methods and developed revised methods to evaluate Round 2 funded facilities. Consequently, methods used to evaluate Round 1 and Round 2 funded facilities differed considerably and results are reported separately. EVALUATION REPORT

17 Evaluation of the Effects of Round 1 Funding Participants In total, 51 facilities received Round 1 funding to implement programs. Thirty-six facilities returned responses to the nurse survey; 46 of the 52 program coordinators returned completed coordinator surveys. Injury data were collected from 44 facilities. Programs Eighty-two per cent of facilities engaged the services of the same consultant to implement Back Injury Prevention Programs. Outcome Measures Round 1 funded facilities were evaluated using three survey instruments designed and distributed by the Department of Human Services Advisory Committee. These were a survey of participating nurses, a survey of the staff member at each facility responsible for coordinating Back Injury Prevention Programs and a survey of incident and injury data before and after program implementation. The nurse survey was a combination of multiple choice questions and questions An example of an outdated lifting practice. 12 VICTORIAN NURSES BACK INJURY PREVENTION PROJECT

18 seeking free text responses about the effects of the programs conducted at their facility. The survey of program coordinators sought similar information, but in addition asked about obstacles to program implementation. Data on injuries to nurses at participating facilities were sought for the periods two years before, one year before and one year after program implementation. Effects of Round 1 Funding Survey of Nurses In all, 807 nurses from 36 facilities responded to the nurse survey. A large volume of nurse responses were collected and analysed. For multiple choice responses, response frequency to each option was calculated. Two assessors independently grouped the free text responses to 25 questions into themes. Themes were typically uncomplicated and there were few disagreements in interpretation. All were resolved through discussion. Numbers of nurses and the numbers of facilities represented by these nurses were calculated for each theme that was concluded from the data. The fully themed document containing all responses was reviewed by the VNBIPP Advisory Committee. Key Findings Nurses clearly accepted programs and welcomed improvements in their work conditions. Many nurses reported that they were very enthusiastic about the benefits of the No Lifting programs, particularly with respect to reduction in injuries and fatigue. One of the best programs I ve ever had implemented in over 25 years nursing. feel less physically tired and patients and residents less traumatised than by manual lifting. I think it is one of the best things to happen in nursing. It has made a huge difference to how tired I feel after a busy shift. There was clear acceptance of the change from hazardous manual handling of patients to the use of patient handling aids and equipment. EVALUATION REPORT

19 ...this is one of the best innovations to be introduced to the health industry especially in the geriatric nursing sector where lifting residents was one of the hardest parts of the job as it would happen times a day. Great system you don t realise how hard it was to physically lift patients until you use the No Lift system. I don t think I could go back. Occurred 20 years too late. Since commencement of the program with strict adherence to the policies and procedures, my previous back pain no longer exists following a hard day s work. This program has helped us to put into action think before doing. Morale up amongst nursing staff. Patients comfortable and secure with lifting apparatus....it has made me more aware of how I am looking after myself. There was clear acceptance of the change from manual handling of patients to the use of patient handling aids and equipment. Eighty-eight per cent of nurses reported that they typically chose to use lifting devices and aids to move or transfer patients. The most commonly adopted patient handling aids and equipment were slide sheets, lifting machines, electric beds, pat slides, walk belts, standing machines and monkey bars. Programs appeared to have been effective in promoting a culture where nurses recognised the potential for injury and were aware of appropriate methods for risk control. Seventy per cent of nurses reported that procedures for hazard identification, risk assessment and risk control had been maintained throughout implementation of the programs. Seventy-five per cent of nurses reported that their programs encouraged early reporting of injuries. Resistance to change from traditional patient handling methods was not evident in responses. Most nurses (77 per cent) believed that programs would result in long term cultural change and a reduction in musculoskeletal injuries. Indicators of Opportunities to Improve Programs Nurses frequently reported concerns that facilities were not designed to accommodate the patient handling equipment. Nurses from 31 per cent of facilities reported inadequate space to store equipment. There appeared to be a widespread shortfall in the amount of equipment available to nurses. Nurses reported wanting to use equipment and not being able to either because they did not have enough equipment (30 per cent of nurses), or because they could not locate it when they wanted it (nurses from 22 per cent of facilities). Other researchers have observed that sharing of mechanical aids can result in disuse due to the inconvenience and time taken to locate them (Moody, 1996). Nurses reported that the following methods had improved equipment access: providing a slide sheet for each patient/resident by their bedside, labeling equipment and equipment parts, recording where equipment is taken, developing a system (e.g. hooks) so that all related equipment parts are stored on or with a mechanical aid, removing a bed so that equipment can be stored in a central/accessible location, designating specific storage areas to which equipment is returned after it is used and reallocating existing spaces to centralise equipment storage. Nurses from 14 per cent of facilities reported that carpeted floors and building design made the task of moving equipment difficult, particularly when equipment is not stored in a central location. A comprehensive patient/resident assessment instrument is the means by which risks associated with patient care are assessed and recommendations for safe handling methods are recorded. Moody (1996) argued that if a patient care plan is used and the method and equipment required for 14 VICTORIAN NURSES BACK INJURY PREVENTION PROJECT

20 patient handling are recorded in this care plan, nurses are more likely to adhere to low risk practices. The present evaluation found that such an instrument was utilised by 64 per cent of nurses and was frequently used on admission. Responses from some facilities indicated that plans were not updated as the patient s condition changed, not filled in correctly or considered too time consuming. The instrument used to assess patient handling needs were devised by individual facilities and varied in their ease of use. This may account for the variable utilisation of these instruments across facilities. In July 2002, WorkSafe Victoria in conjunction with the Health and Aged Care Industry released the report Transferring people safely: a practical guide to managing risk handling patients, residents and clients in health, aged care, rehabilitation and disability services. The report includes practical and comprehensive instruments for assessing patient handling requirements. These instruments, in offering a simple and standardised assessment method, may achieve widespread uptake and consistent utilisation. Survey of Program Coordinators Program coordinators also reported support for programs. They used the following methods to encourage nurse ownership of programs: emphasising the importance of programs to the health of staff, encouraging nurses to manage programs themselves, encouraging nurses to evaluate and decide on their equipment needs, demonstrating management support and encouraging feedback from nurses. Coordinators reported using an extensive list of methods for encouraging feedback about programs from nurses. These included regular program meetings, workshops, complaints and comments boxes, regular newsletters, staff meetings, appointing individuals with responsibility to liaise/report to occupational health and safety representatives or suitable management staff, risk assessment processes, compliance monitoring and equipment audits. These appear to be appropriate methods for providing nurses with the opportunity to convey concerns about the program or about their work practices to program coordinators. Dedicated staff were considered to be an important component in sustaining programs, however coordinators reported that they were not always available. They also reported that part time staffing disrupted the continuity needed for regular consultation about manual handling concerns and the development of risk reduction strategies. The feedback from the nurses and coordinators indicated that programs were accepted and aligned with the Project aims. Almost all nurses who had attended No Lifting training reported that the programs: Included training to nursing staff in hazard identification, risk assessment and risk control. Covered the effects of manual handling on the human body. Provided training to nursing staff on No Lifting techniques aimed at eliminating/minimising manual handling of patients/residents. Encouraged maximum patient/resident mobility and independence, whilst maintaining patient dignity. Emphasised that patient/resident and staff needs are equally considered and important. There were clearly obstacles to be overcome, in particular ensuring that nurses had adequate patient handling aids and equipment and enough room to store and operate equipment. A comprehensive and standardised patient assessment instrument able to be easily completed by nurses was required. Dedicated staff required to sustain programs were not uniformly available. Overall however, Round 1 survey data provided convincing evidence that nurses were willing to make the change to No Lifting practices and that program content was typically aligned with Project objectives. EVALUATION REPORT